D-D联合Lp-PLA2对AMI患者PCI术后发生ISR的预测价值

Predictive value of D-D combined Lp-PLA2 for ISR in AMI patients after PCI

目的:研究D-二聚体(D-D)联合脂蛋白相关磷脂酶A2(Lp-PLA2)对急性心肌梗死(AMI)患者经皮冠脉介入治疗(PCI)术后发生冠脉支架内再狭窄(ISR)的预测价值。方法:选择于我院行PCI术的153例AMI患者作为AMI组,另选择同期健康体检者158例作为健康对照组,比较两组血清D-D、Lp-PLA2水平。依据是否发生ISR,AMI组被分为ISR组(31例)和无ISR组(122例),比较两组临床资料。分析AMI患者PCI术后发生ISR的影响因素,及血清D-D、Lp-PLA2水平对AMI患者PCI术后发生ISR的预测价值。结果:与健康对照组比较,AMI组血清D-D、Lp-PLA2水平均显著升高(P均=0.001)。与无ISR组比较,ISR组血清尿酸(UA)、C反应蛋白(CRP)、D-D、Lp-PLA2水平均显著升高(P均=0.001)。多元Logistic回归分析显示,UA、CRP、D-D、Lp-PLA2均为AMI患者PCI术后发生ISR的独立危险因素(OR=1.022~1.100,P<0.05或<0.01)。ROC曲线分析显示,血清D-D、Lp-PLA2水平及二者联合预测AMI患者PCI术后发生ISR的曲线下面积分别为0.862、0.848、0.918,灵敏度分别为87.10%、80.65%、80.65%,特异度分别为78.69%、83.61%、95.90%,两项联合检测特异度显著高于各项单独预测(P均<0.01)。结论:血清D-D、Lp-PLA2水平均是急性心肌梗死患者PCI术后发生ISR的独立危险因素,且对其具一定的预测价值,二者联合预测效能更高。

Objective: To study predictive value of D-dimer(D-D) combined lipoprotein-associated phospholipase A2(Lp-PLA2) for coronary in-stent restenosis(ISR) in patients with acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI). Methods:A total of 153 AMI patients undergoing PCI in our hospital were selected as AMI group. Another 158 healthy volunteers were simultaneously regarded as healthy control group. Serum levels of D-D and Lp-PLA2 were compared between two groups. According to whether ISR occurred, AMI group was further divided into ISR group(n=31) and no ISR group(n=122), and clinical data were compared between two groups. Influencing factors of ISR and predictive value of serum levels of D-D and Lp-PLA2 for ISR in AMI patients after PCI were analyzed. Results:Compared with healthy control group, there were significant rise in serum levels of D-D and Lp-PLA2 in AMI group(P=0.001 both). Compared with no ISR group, there were significant rise in serum levels of uric acid(UA), C reactive protein(CRP), D-D and Lp-PLA2 in ISR group(P=0.001 all). Multiple Logistic regression analysis indicated that UA, CRP, D-D and Lp-PLA2 were independent risk factors for ISR in AMI patients after PCI(OR=1.022~1.100, P<0.05 or <0.01). ROC curve analysis indicated that areas under curve of serum levels of D-D and Lp-PLA2 and combined detection for predicting ISR in AMI patients after PCI was 0.862, 0.848 and 0.918 respectively;sensitivity was 87.10%, 80.65% and 80.65% respectively;specificity was 78.69%, 83.61% and 95.90% respectively;specificity of combined detection was significantly higher than those of single detections(P<0.01 all). Conclusion: Serum levels of D-D and Lp-PLA2 are independent risk factors for ISR in patients with acute myocardial infarction after PCI and possess certain predictive value for it, and predictive efficacy of combined detection is higher.